Introduction: Cardiac disease called acromegalic cardiomyopathy may be present in patients with acromegaly at diagnosis, however most echocardiographic studies showed that systolic function, measured by ejection fraction (EF), in these patients is normal. Speckle tracking echocardiography (STE) is a novel method that allows for the study of global longitudinal strain (GLS), a marker of early and subclinical left ventricular (LV) systolic dysfunction. Some studies show subclinical systolic dysfunction in the untreated acromegalic patients. It cannot be ruled out that the LV function measured with GLS improves as an effect of acromegaly treatment.
Objective: To assess the effect of acromegaly treatment on left ventricular GLS in patients with normal EF.
Patients and methods: Twenty consecutive patients (mean age 49±14 years) with naïve acromegaly admitted to our department in 2018 were enrolled in the prospective study. The patients were preoperatively treated with somatostatin analogs (lanreotide autogel or octrotide LAR) while awaiting for pituitary surgery. All patients with normal systolic LV function measured by ejection fraction (EF) underwent 2D-STE at baseline and after 3, 6 months of medical treatment and 3 months after pituitary surgery.
Results: The median GH was increased at baseline [in ug/l, 5.06 (IQR: 0.669.3)] and decreased significantly after 3 and 6 months of somatostatin analog treatment and after surgery [in ug/l 1.29 (IQR: 0.0534.9), 1.24 (IQR: 0.120.9), 0.31 (IQR: 0.054.92), P<0.05, respectively]. The mean IGF-1 level was increased at baseline (in xULN, 2.89±1.06) and decreased significantly after 3 and 6 months of somatostatin analog treatment and 3 months after surgery (in xULN, 1.54±0.92; 1.86±1.24; 1.47±0.86, P<0.05, respectively). The mean GLS in patients with acromegaly at baseline was below the normal range (in%, −18.74±2.64) and increased 3, 6 months after somatostatin analog treatment and 3 months after surgery (in%, −19.38±2.76; −19.21±2.88; −20.88±1.75, respectively), although statistical significance (P<0.05) was reached only between GLS at baseline and GLS measured in patients 3 months after pituitary surgery. There was no statistical significant correlation between baseline GLS and GH or IGF-1 concentrations.
Conclusions: Untreated acromegalic patients presented with subclinical systolic dysfunction expressed by decreased GLS. Systolic LV function improves as an effect of acromegaly treatment, particularly after pituitary surgery along with the decrease of GH and IGF-1 concentrations. The effective medical and surgical treatment of acromegaly may be responsible for prevention of development an overt cardiac insufficiency in acromegalic patients.
18 May 2019 - 21 May 2019